After reading your editorial "Just say 'Yes'"
in the October issue (2009;10:6-7) I was struck by your comment that you
do not know how such matters play out in the private setting. I'm a
radiologist in private practice in Minneapolis working in a large group
practice that covers several hospitals, so I can give you one example of
how this situation plays out.

Our practices are busy enough that the hospitals staff the
departments with ultrasound technologists overnight in the busiest
hospitals and they are on-call in more peripheral hospitals. We learned
long ago that the best policy is to say "yes" to every exam.
But our take on inappropriate exams (non-emergency) used to be to call
the report and then give gentle education that the exam in a similar
patient in the future could likely wait until the morning. Those days
have gone by the wayside.

These days, though, the ERs are like walk-in clinics to patients,
and the ER physicians have learned to work-up most issues while the
patient is there. So the emergency nature of scans is simply defined by
the fact that the patient presented to the ER. We have no incentive to
turn away scans since we have a radiologist reading them all evening and
all night via teleradiology for 5 hospitals and 2 clinics. Also, making
patients wait until the morning because of our hospitals' staffing
shortfalls is not good customer service.

Since Applied Radiology is a practical journal, I'd like to
suggest that you consult with private practice radiologists in the
future to gain their perspectives on practice issues. We can learn from
each other!